Dataset Information

In-Hospital Cardiac Arrest in United States Emergency Departments, 2010-2018.

ABSTRACT:

Background

Little is known about the in-hospital cardiac arrest (IHCA) in the US emergency department (ED). This study aimed to describe the incidence and mortality of ED-based IHCA visits and to investigate the factors associated with higher incidence and poor outcomes of IHCA.

Materials and methods

Data were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) between 2010 and 2018. Adult ED visits with IHCA were identified using the cardiopulmonary resuscitation code, excluding those with out-of-hospital cardiac arrest. We used descriptive statistics and multivariable logistic regression accounting for NHAMCS's complex survey design. The primary outcome measures were ED-based IHCA incidence rates and ED-based IHCA mortality.

Results

Over the 9-year study period, there were approximately 1,114,000 ED visits with IHCA. The proportion of IHCA visits in the entire ED population (incidence rate, 1.2 per 1,000 ED visits) appeared stable. The mean age of patients who visited the ED with IHCA was 60 years, and 65% were men. Older age, male, arrival by ambulance, and being uninsured independently predicted a higher incidence of ED-based IHCA. Approximately 51% of IHCA died in the ED, and the trend remained stable. Arrival by ambulance, nighttime, or weekend arrival, and being in the non-Northeast were independently associated with a higher mortality rate after IHCA.

Conclusion

The high burden of ED visits with IHCA persisted through 2010-2018. Additionally, ED-based IHCA survival to hospital admission remained poor. Some patients were disproportionately affected, and certain contextual factors were associated with a poorer outcome.

SUBMITTER: Sung CW

PROVIDER: S-EPMC9035594 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

In-Hospital Cardiac Arrest in United States Emergency Departments, 2010-2018.

Sung Chih-Wei CW Lu Tsung-Chien TC Wang Chih-Hung CH Chou Eric H EH Ko Chia-Hsin CH Huang Chien-Hua CH Chen Wen-Jone WJ Tsai Chu-Lin CL

Frontiers in cardiovascular medicine 20220411

<h4>Background</h4>Little is known about the in-hospital cardiac arrest (IHCA) in the US emergency department (ED). This study aimed to describe the incidence and mortality of ED-based IHCA visits and to investigate the factors associated with higher incidence and poor outcomes of IHCA.<h4>Materials and methods</h4>Data were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) between 2010 and 2018. Adult ED visits with IHCA were identified using the cardiopulmonary resusc ...[more]

PMID: 35479284

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Project description:IntroductionThe receipt of remote clinical care for children via telecommunications (pediatric telemedicine) appears to improve access to and quality of care in U.S. emergency departments (EDs), but the actual prevalence and characteristics of pediatric telemedicine receipt remain unclear. We determined the prevalence and current applications of pediatric telemedicine in U.S. EDs, focusing on EDs that received telemedicine from clinicians at other facilities.MethodsWe surveyed all 5,375 U.S. EDs to characterize emergency care in 2016. We then randomly surveyed 130 (39%) of the 337 EDs who reported receiving pediatric telemedicine. The second survey was administered by phone to ED directors primarily. It confirmed that the ED received pediatric telemedicine services in 2017 and asked about ED staffing and the nature, purpose, and concerns with pediatric telemedicine implementation.ResultsThe first survey (4,507/5,375, 84% response) showed that 337 (8%) EDs reported receiving pediatric telemedicine. Among the randomly sampled EDs completing the second survey (107/130, 82% response), 96 (90%) confirmed 2016 use and 89 (83%) confirmed 2017 use. Reasons for discontinuation included technical and scheduling concerns. Almost all who confirmed their pediatric telemedicine use in 2017 also reported 24/7 availability (98%). The most widely reported use was for patient placement and transfer coordination (80%). Many EDs (39%) reported no challenges with implementing pediatric telemedicine and described its utility. However, the most frequently reported challenges were process concerns (30%), such as concerns about slowing or interrupting providers' work flow and technological concerns (14%).ConclusionFew EDs receive telemedicine for the delivery of pediatric emergency care nationally. Among EDs that do use telemedicine for pediatric care, many report process concerns. Addressing these barriers through focused education or interventions may support EDs in further developing and optimizing this technological adjunct to pediatric emergency care.

Project description:BACKGROUND:Cardiac arrest in hospitalized children is associated with poor outcomes, but no contemporary study has reported whether the trends in survival have changed over time. In this study, we examined temporal trends in survival for pediatric patients with an in-hospital pulseless cardiac arrest and pediatric patients with a nonpulseless cardiopulmonary resuscitation event from 2000 to 2018. METHODS:This was an observational study of hospitalized pediatric patients (≤18 years of age) who received cardiopulmonary resuscitation from January 2000 to December 2018 and were included in the Get With The Guidelines-Resuscitation registry, a United States-based in-hospital cardiac arrest registry. The primary outcome was survival to hospital discharge, and the secondary outcome was return of spontaneous circulation (binary outcomes). Generalized estimation equations were used to obtain unadjusted trends in outcomes over time. Separate analyses were performed for patients with a pulseless cardiac arrest and patients with a nonpulseless event (bradycardia with poor perfusion) requiring cardiopulmonary resuscitation. A subgroup analysis was conducted for shockable versus nonshockable initial rhythms in pulseless events. RESULTS:A total of 7433 patients with a pulseless cardiac arrest and 5751 patients with a nonpulseless event were included for the analyses. For pulseless cardiac arrests, survival was 19% (95% CI, 11%-29%) in 2000 and 38% (95% CI, 34%-43%) in 2018, with an absolute change of 0.67% (95% CI, 0.40%-0.95%; P<0.001) per year, although the increase in survival appeared to stagnate following 2010. Return of spontaneous circulation also increased over time, with an absolute change of 0.83% (95% CI, 0.53%-1.14%; P<0.001) per year. We found no interaction between survival to hospital discharge and the initial rhythm. For nonpulseless events, survival was 57% (95% CI, 39%-75%) in 2000 and 66% (95% CI, 61%-72%) in 2018, with an absolute change of 0.80% (95% CI, 0.32%-1.27%; P=0.001) per year. CONCLUSIONS:Survival has improved for pediatric events requiring cardiopulmonary resuscitation in the United States, with a 19% absolute increase in survival for in-hospital pulseless cardiac arrests and a 9% absolute increase in survival for nonpulseless events between 2000 and 2018. However, survival from pulseless cardiac arrests appeared to have reached a plateau following 2010.

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Dataset Information

In-Hospital Cardiac Arrest in United States Emergency Departments, 2010-2018.

Background

Materials and methods

Results

Conclusion

Publications

In-Hospital Cardiac Arrest in United States Emergency Departments, 2010-2018.

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